Introduction

It has been reported that lymph node density is superior to TNM nodal status in predicting oncologic outcome after radical cystectomy (RC) for urothelial carcinoma of bladder (UCB). The survival benefits of adjuvant chemotherapy (AC) following RC according to LND were assessed in this study.

Methods

Of 888 consecutive UCB patients undergoing RC with pelvic lymph node dissection (PLND), 164 (18.5%) received the AC. After controlling preoperative and postoperative clinical and pathological variables, recurrence-free (RFS) and cancer-specific survival (RFS) after RC with PLND were compared between the AC and non AC groups.

Results

After the strict propensity scored matching (both discard, caliper=0.1), 130 patients with AC were not significantly different with 130 matched patients without AC, in age (62.5 vs. 61.8 years), pT stage (≥pT3, 78.5 vs. 77.7%), pN stage (pN1, 23.8 vs. 30.8% ;≥pN2, 32.3 vs. 32.3%), tumor grade (high, 95.4 vs. 87.7%), carcinoma in situ (23.1 vs. 28.5%), lymphovascular invasion (62.3 vs. 58.5%), positive surgical margin (10.0 vs. 10.0%), dissected LN number (19.8 vs. 22.4), and LN density (0.14 vs. 0.15; p range, 0.071-1.000). During median 43.0 months follow-up after the RC with PLND, median RFS of AC group was similar to that of non AC group (37.0 vs. 30.0 months, p=0.612). CSS were not also different between two groups (60.0 vs. 55.0 months, p=0.313). However, better RFS (20.0 vs. 9.0 months, p=0.008) and CSS (44.0 vs. 18.0 months, p=0.009) of AC group were observed in subgroup of patients with LND ≥0.05 (N=122).

Conclusions

After adjusting the possible confounders and selection biases, AC demonstrated better oncological outcomes in patients with LND ≥0.05. Patients with LND ≥0.05 on final pathology should be considered the AC for better survival outcomes.

Funding

None